Leveraging Immersive Technology to Transform Veterans Healthcare Delivery

Immersive technologies, also known under the umbrella term of extended reality (ER), offers a distinct experience merging the physical world with a digital or simulated reality. Augmented reality (AR), mixed reality (MR), and virtual reality (VR) are types of immersive technologies. These technologies share many of the same qualities. The GAO Science & Tech Spotlight: Extended Reality Technologies, GAO-22-105541 does a nice job of unpacking the various aspects of immersive technologies: AR overlays digital content onto representations of the real environment, using smartphones, tablets, or AR glasses. MR uses dedicated headset recognizes its environment and enables the interaction between digital content and the real world in multiple dimensions. VR completely obscures the real world, immersing users in digital environments using head-mounted displays.  

These technologies are impacting many domains across many sectors, but one of the most promising areas is its use and application in transforming healthcare and how its delivery. The U.S. Department of Veterans of Affairs, through its VA Immersive initiative, is leading the way in the clinical implementation of immersive technology.

Recently, Dr. Anne Bailey, executive director, Strategic Initiatives Lab (Strat Lab) within the Veterans Health Administration joined me on The Business of Government Hour to explore how VA is using immersive technology to define a new reality in Veteran healthcare. We discuss the mission and strategic priorities of the Strat Lab, detail the benefits of using immersive in healthcare, and ponder what the future holds. 

On the Mission of the Strategic Initiatives Lab. The Strategic Initiatives Lab or the Strat Lab exists to complete discovery, test, and early evaluation of emerging and high‑risk technologies like immersive technology. We want to help facilitate the next‑step, posing the following questions: do we take this effort further? do we let it die because it didn't work? We want to build a repeatable process that facilitates the implementation of such technologies. Some of the ways we do this are through communities of practice, providing playbooks, and implementation guides. We are a place with disruptive technologies can grow. 

The creation of the Strat Lab was prompted by an identified need to have a skilled team dedicated to identifying these innovative opportunities and take on the heavy lift of the early testing and evaluation. This will allow VA to be more agile without expending unnecessary resources on things that might fail. If they prove effective, then we could truly change the landscape of healthcare delivery. We're certainly seeing this in our work in immersive technology like augmented reality, mixed reality, and virtual reality. We are a place where disruptive technologies can grow. 

My number one responsibility, to be quite honest, is to invest in the wonderful team I work with each day. It's my responsibility to identify technical opportunities that show promise and then advocate for support to evaluate them. Doing this well includes that I do a lot of listening, networking, identifying value propositions, and then being able to effectively communicate that to key stakeholders.

On Strategic Vision and Priorities. Every decision we make and direction we take must be defined by the needs of veterans and in alignment with executive leadership priorities. We also want to maintain a “problem-first” approach -- where we really understand the problems we're trying to solve, rather than just finding a bunch of solutions and then try to find a problem that they align with. 

VA Immersive exists to define a new reality in healthcare delivery and experience. Immersive technology has grown significantly in VA over the past seven years with real impact over the last three. When we refer to immersive technology we're talking about virtual reality, mixed reality, augmented reality, and now spatial computing, with VR being by far the most common in VA. What we have found is that immersive technology is an incredibly engaging tool that is making a positive impact on veterans but it is also facilitating serious collaboration across the VA enterprise. 

We have three priorities for the lab. Our number one priority is innovation. We want to take risks and do things differently. We are doing that today with our efforts leveraging immersive technology to care for and in service of veterans.  As we identify innovations, we then have to scale them. We do this by prioritizing and asking the core questions about how we prioritize things. What do we do when it's time to let things die, to kill them, or to carry them forward. From innovating to scaling them, the third priority, is to systematize the innovation. Once an innovation scales now we want to make it normal, hand it off, and systematize it – and start the entire process over again! What I love about the lab is that we get to be agile and evolve.

On Leadership. I want to be able to lead by example by being a servant leader. Some of the work we do can be tedious and somewhat boring to be frank. Thought I may despise that as much as anyone, I know that it is necessary. Therefore, I recognize I must do what I ask my team to do. Accountability, integrity, teachability, and humility are all the traits I want in a leader. I try to embody those qualities as such I surround myself with people who hold me accountable to them. I want to significantly decrease the chance that at any point I would lead with arrogance or obstinance.

The work we do is not for everybody. Identifying an innovation that works and has appreciable impact, is wonderful and fun. That said, getting to that point requires a lot of tenacity, patience, grit, and humility. Being an effective leader requires a core team in which to lead. Patrick Lencioni calls the ideal team player, which could apply to an ideal leader that they are hungry, humble, and smart. As a leader, we must care deeply about serving veterans and addressing the problems they face.

On Using XR in Chronic Pain Management. We are overseeing two different chronic pain-specific related implementations. Let me highlight one that is for at‑home chronic low back pain management. These projects are funded by different offices in the VA. We contribute the immersive technology to these projects. For example, our collaboration with the Office of Pain Management combats Veterans’ chronic pain by increasing access to at-home virtual reality sessions that teach the skills needed to better manage chronic pain. The approach allows veterans to effectively treat chronic pain symptoms from the comfort of their own homes without compromising the effectiveness of their care. It also decreases reliance on pharmacological modalities, significantly reducing the possibility of addiction.  

On the VA Immersive Summit. We look forward to the VA Immersive Summit each year because it's where everyone comes together -- VA staff and executives, our collaborators from industry and academia, and most importantly veterans themselves who have benefited from this technology and our efforts. 

Our last summit was August of 2023. We had over 200 people in person with more than 500 joining us online. It is two and a half days of hearing from veterans and staff, telling stories, and then getting a sense of what’s next. The consensus at the end of that summit was everybody wanted more access to this technology. They want more training and education both for veterans and for staff on how to use the technology and then more data on how we best to implement it going forward.

On the Future. We've heard repeatedly that VA is the global leader of clinical implementation of immersive technology. We're excited about it. We believe in VA's ability to effect change. We want to use our size and scale to transform global healthcare. We also think this helps us to attract and retain the best and brightest because there are real opportunities to do life‑changing things within VA. 

I would also like to highlight some other accomplishments. The Innovation Ecosystem has partnered with the field to embed physical therapy into primary care -- an effort that sets the example for other transformational care models. The Center for Care and Payment Innovation is designed to test and evaluate innovation in the business and care model space. SimLEARN, which is all about improving the quality of health care services for America’s Veterans through the application of simulation-based learning strategies to clinical workforce development. It launched the SimVET program, where they are looking at emerging technologies and evaluating them in a simulated environment to ensure safety for whatever touches a patient. Advanced manufacturing received VA's first compassionate use designation from the FDA for a Gio stent, a 3D-printed hearing device, that was designed for a South Carolina veteran with a rare form of hearing loss, who got to name it. It is named after his grandson. These are just a handful of accomplishment, but VA has vast potential to lead and define healthcare innovation. I'm looking forward to seeing what that looks like as we move forward.